Hipercalcemia severa en el curso de rabdomiolisis: caso clínico / Rhabdomyolysis and severe hypercalcemia: report of one case

Rhabdomyolysis (RD) is the process that leads to cell destruction of striated muscle. Causes include inherited metabolic defects or acquired disorders. RD is frequently associated with acute kidney injury (AKI) and disorders of calcium metabolism. We report a 33 year old man that after amphetamine consumption and an uninterrupted 3,000 km driving presented vomiting, muscle pain and dark urine. He had elevated creatinkinase levels, severe hypocalcemia and an acute renal failure. He was treated with hemodialysis and calcitriol. He was transferred to our hospital and on admission a serum calcium of 18 mg/dl was detected. He continued on hemodialysis, recovering renal function and with normalization of creatinkinase levels and serum calcium level.

Vigencia del efecto placebo: su biología desde la genética a la conducta / Biological and genetic mechanisms underlying the placebo effect

The placebo effect has been seldom studied in the history of medicine. However, during the last decades, the great impact of this phenomenon in clinical practice, ranging from surgical to psychiatric field, has been revealed. Research elucidated both the psychological mechanisms and genetic polymorphisms that affect the susceptibility of individuals to express this phenomenon. We herein review the psychological mechanisms, brain structures (anterior cingulate cortex, nucleus accumbens, dorsolateral prefrontal cortex, insular cortex, thalamus) and neurotransmission systems involved (opioid, dopaminergic, cannabinoid, serotoninergic, cholecystokinin). These are the clue to recognize the polymorphisms that have been identified so far. The biological basis of both the placebo effect and its alter ego, the nocebo effect, are well recognized, and related to corresponding psychological processes. Finally, the implications of the findings in clinical practice and medical training are discussed.

Consumo de sustancias ilícitas y psicotrópicos entre los estudiantes de medicina de la Pontificia Universidad Católica de Chile / Illicit and psychotropic drug use among medical students at the Pontificia Universidad Católica de Chile

Background: Illicit drug abuse is a public health problem, generally starting in adolescence. Medical students are not an exception. Aim: To assess the consumption of illicit drugs among medical students of the Pontificia Universidad Católica de Chile. Material and Methods: A questionnaire used by the National Council for the Control of Substance Abuse (CONACE) to evaluate substance use and the Goldberg Health Questionnaire (GHQ-12), were applied to medical students. The questionnaires were self administered under supervision. Results: The survey was completed by 569 of 775 students (74%). “Ever used” reached 33% for marijuana, 1.1% for cocaine, 2.1% for amphetamines without prescription, 6.9% for not prescribed benzodiazepines and 5.8% for not prescribed antidepressants. The use of these substances was only associated for ever used marijuana and level of career (p <0.01), with the highest rate in the seventh final year (51.4%). Benzodiazepine use was also associated with the level of career (p <0.01) withless than 6% prevalence from first to fourth and the highest in seventh year (32.4%). Non prescribed antidepessant use was significantly higher among women. Tobacco and alcohol use were associated with consumption of marijuana (p <0.0001) and benzodiazepines (p <0.0001). Conclusions: Our medical students have low marijuana consumption rates, only above Turkey. Cocaine and amphetamines use is low, benzodiazepine consumption is higher among final year students. Antidepressant use is higher among women.

Consumo de tabaco y alcohol entre los estudiantes de medicina de la Pontificia Universidad Católica de Chile / Smoking and alcohol drinking among medical students at the Pontificia Universidad Católica de Chile

Background: Tobacco and alcohol consumption are public health problems, generally starting in adolescence. Medical students are not an exception. Aim: To determine the characteristics of tobacco and alcohol use among medical students at the Pontificia Universidad Católica de Chile and their association with gender, career level and mental health. Material and methods: A questionnaire to evaluate substance use was applied along with Goldberg Health Questionnaire (GHQ-12), as a mental health risk predictor, to all medical students in November 2005- Results: The survey was completed by 569 of 775 students (74 percent). Current smokers were 23- 7 percent, with the lowest figure, 13-5 percent in sixth year, and the highest, 40.5 percent in seventh year (p <0.01). Thirty one percent of students with an score of five and over in the GHQ-12 were smokers, compared to 19 percent among those with a lower score. Daily smokers were 40 percento of the current smokers. Seventy four percent of students consumed alcohol during the last month. No association with sex or GHQ-12 was observed. The lowest alcohol consumption rate was observed in second year, and the highest in sixth year (66 percento and 89-2 percento, respectively, p <0.01). Fifty three percent of men and 26 percento of women drank three or more drinks in any given day (p <0.01). Sixty three percent of men and 81 percent of women never drank more than five drinks in one day, during the last month (p <0.01). Conclusions: Our medical students smoke less than Chilean youth but more than medical students of countries such as the USA. They drink less than Anglo-Saxon medical students but more than Chilean youth. Male consumption is greater than that of women. Smoking and alcohol drinking are mutually associated.

Síndrome de discontinuación de antidepresivos / Withdrawal syndrome of antidepressants

Introducción: Considerando el amplio uso de los antidepresivos evaluamos la existencia y características del síndrome de discontinuación de antidepresivos. Métodos. Usando MEDLINE identificamos reportes y artículos de revisión relevantes acerca de síntomas secundarios al retiro de antidepresivos. Resultados. Existe amplia evidencia acerca de un síndrome de discontinuación tras el retiro de antidepresivos tricíclicos, inhibidores de la monoaminooxidasa e inhibidores de recaptura de serotonina, habiéndose descrito desde molestias leves a cuadros severos con síntomas psicóticos y agitación, siendo en general más graves los síntomas asociados a discontinuación de inhibidores de la manoamino-oxidasa y tricíclicos. Conclusiones. La información obtenida debe ser considerada por los clínicos al momento de prescribir el inicio o retiro de antidepresivos. Debe tenerse en cuenta el síndrome de discontinuación de antidepresivos en pacientes que presentan bruscas exacerbaciones sintomáticas. Se sugiere como medida preventiva la disminución gradual de las dosis antes de suspender un antidepresivo

Personalidad premórbida en los trastornos del ánimo y en la esquizofrenia: un estudio empírico / Pre-morbid personality in mood disorders and schizophrenia: an empirical study

Numerosos autores han asociado ciertos rasgos de la personalidad a las diferentes formas de trastorno mental. Las depresiones unipolares han sido asociadas a una estructura de personalidad premórbida rígida, fijada al rol y al orden e intolerante a la ambigüedad. Los trastornos bipolares a estructuras cambiantes, flexibles, creativas y sociables y los trastornos esquizofrénicos a rasgos introvertidos. Este trabajo analiza empíricamente las características e interacciones entre algunos constructos de la personalidad premórbida y los trastornos de ánimo y esquizofrénicos. 20 pacientes bipolares, 27 depresivos unipolares y 17 esquizofrénicos, diagnósticados de acuerdo al DSM-III R e ICD-10 y hospitalizados en la Clínica Psiquiátrica de la Universidad de Chile, junto a un grupo control, fueron comparados psicométricamente mediante escalas F, MP-T y de Intolerancia a la ambigüedad de Kischkel, todas de autoevaluación, junto a la escala MP-T de evaluación externa. Los pacientes debieron completar las escalas al momento del alta, encontrándose asintomáticos. El análisis de covarianza de los resultados demostró mayores índices de rígidez e intolerancia a la ambigüedad para el grupo depresivo unipolar, mayores valores de rasgos ciclotímicos como flexibilidad, creatividad y sociabilidad para el grupo bipolar y menores índices de extroversión para el grupo esquizofrénico. Los resultados confirman hallazgos previos registrados en Alemania y Japón, corroborando la hipótesis de que esas formas de personalidad son independientes de las influencias culturales. Finalmente se discute el significado de estos hallazgos para la comprensión de la patogénesis, la psicopatología, las formas de evolución y el adecuado tratamiento de estos trastornos

El sistema A.M.D.P. en la evaluación psicopatológica / The A.M.D.P. system in psychopathological evaluation

Numerosos estudios psicométricos han demostrado reiteradamente discrepancias significativas en la definición y concepción de terminología en psiquiatría clínica. En este trabajo se presenta el sistema de categorización psicopatológica AMDP en su versión española, anexando un formulario de evaluación graduada y un listado de ejemplos comunes. Analizando comparativamente las diferentes estrategías e instrumentos de evaluación psicopatológica se intenta discutir las cualidades e imperfecciones del sistema AMDP. Finalmente es subraya la necesidad de homogenizar las definiciones psicopatológicas con el objeto de aumentar la confiabilidad y la comparabilidad de la información psiquiátrica utilizada en clínica, docencia e investigación